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TOPLINE:

Among emergency department (ED) patients with suspected renal colic who underwent renal point-of-care ultrasound (rPOCUS), hydronephrosis predicted kidney stones and early urologic intervention and was linked to increased CT use and similar length of stay (LOS) in the ED.

METHODOLOGY:

• Researchers conducted a retrospective cohort study at an urban academic ED and included adults aged 18 years or older who underwent rPOCUS for suspected renal colic between 2020 and 2022.
• A total of 188 patients were included in the analysis, and 47% demonstrated hydronephrosis on rPOCUS.
• CT use and ED LOS were compared between patients with hydronephrosis identified on rPOCUS and those without. Secondary outcomes included the presence of stones on CT, hospital admission, and urologic intervention within 24 hours and 30 days.
• Researchers identified predictors of CT use, early intervention, and ED LOS after adjusting for age, sex, symptom duration, abdominal tenderness, infection, prior nephrolithiasis, and prior urologic procedures.

TAKEAWAY:

• CT imaging was performed for 108 patients and was more common among those with hydronephrosis on rPOCUS than among those without hydronephrosis (72% vs 44%; odds ratio [OR], 3.20; 95% CI, 1.76-5.95). After adjustment, hydronephrosis could independently predict CT use (adjusted OR, 2.63; 95% CI, 1.29-5.46).
• Among patients who underwent CT, hydronephrosis on rPOCUS was a predictor of ureteral stones (74% vs 30%; OR, 6.71; 95% CI, 2.90-16.40) and urologic procedures within 24 hours (26% vs 6%; OR, 5.40; 95% CI, 2.21-15.29).
• The mean ED LOS did not differ between patients with hydronephrosis identified on rPOCUS and those without; however, among patients with hydronephrosis, LOS was 90 minutes longer when CT was performed vs not performed (P = .018), whereas among those without hydronephrosis, LOS was 72 minutes longer when CT was performed (P = .026).
• Clinically significant alternative diagnoses were rare, occurring in 1.6% of patients, and were observed only in patients without hydronephrosis who underwent CT imaging.

IN PRACTICE:

"Hydronephrosis identified on rPOCUS was associated with ureteral stone presence and early urologic intervention among ED patients with suspected renal colic. Notably, hydronephrosis on rPOCUS was associated with increased, rather than decreased, CT utilization in this cohort," the authors wrote.

SOURCE:

The study was led by Mark D. Scheatzle, MD, MPH, Allegheny General Hospital, Pittsburgh. It was published online on April 12, 2026, in The Journal of Emergency Medicine.

LIMITATIONS:

The single-center retrospective design of the study limited the generalizability of the findings to settings with different ultrasound expertise and workflows. The study was also subject to potential selection bias due to clinician-directed rPOCUS use, confounding by indication in CT ordering, outcome assessment limited to the CT subgroup, possible misclassification from unverified rPOCUS interpretations, and unmeasured system factors such as crowding and staffing that may have affected the ED LOS.

DISCLOSURES:

The study received no funding. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.